Compliance Ops Prog Manager

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
• Children's Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
• Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

JOB SUMMARY

The Compliance Operations Program Manager partners with cross-functional teams to integrate compliance requirements into daily workflows, validate process integrity through documentation review and system testing, and ensure regulatory expectations are consistently embedded within performance metrics and service delivery standards.

This role provides oversight of the complaint intake, triage, and resolution process by ensuring timely investigations, thorough documentation, and appropriate corrective actions. The Program Manager also facilitates cross-departmental reviews of complaints and investigations to identify trends, mitigate risks, and strengthen organizational accountability and responsiveness.

JOB SPECIFICATIONS AND CORE COMPETENCIES

Investigations & Issue Resolution

Lead internal investigations related to compliance concerns, operational irregularities, and potential regulatory violations. Collect and analyze documentation, data, and stakeholder input; prepare clear, well-structured reports of findings; and collaborate with Legal, HR, and operational leaders to design, implement, and monitor corrective and preventive actions that address root causes and reduce future risk exposure.

GRC Platform Administration

Administer and enhance the Governance, Risk, and Compliance (GRC) system to support enterprise-wide tracking of regulatory requirements, audits, issue management, and policy lifecycle documentation. Configure the platform to align with organizational workflows, safeguard data integrity, enable real-time reporting, and promote cross-functional collaboration. Continuously assess system performance, implement enhancements, and provide training to ensure adoption and effective use across business units.

Policy Governance & Lifecycle Management

Oversee the end-to-end policy lifecycle, ensuring that new and revised policies are reviewed for regulatory alignment, approved through governance protocols, and implemented consistently across all impacted business areas. Maintain version control, track changes, and communicate updates with documented evidence of operational adoption, including integration into procedures, systems, and training materials.

Business Leader Engagement

Partner with operational leaders to translate policy updates into practical application within departmental workflows. Ensure requirements are accurately documented in systems and manuals, reinforced through communication and training, and monitored for compliance through performance metrics and review processes.

Stakeholder Collaboration

Collaborate with leaders across departments to ensure consistent interpretation, adoption, and execution of policy and compliance requirements. Facilitate cross-functional coordination to confirm updates are effectively implemented, communicated, and reinforced through education, monitoring, and ongoing compliance validation.

Compliance Integration into Operations

Work with functional teams across the organization to embed compliance standards into daily operations. Validate process integrity through documentation review and system testing, and ensure regulatory requirements are reflected in activities, metrics, and service delivery standards. Support continuous improvement by identifying gaps, guiding remediation efforts, and promoting a culture of accountability and compliance excellence.

Actively contributes to the achievement of departmental goals, as identified in the Departments annual business plan, including specific departmental process improvement plans, and other duties as assigned.

QUALIFICATIONS:

Education/Specialized Training/Licensure: Bachelor's degree in healthcare administration, Compliance, Business, or related field, or equivalent combination of education and relevant experience required.

Master's in healthcare administration, Public Health, Business, or related field preferred.

Certification in Healthcare Compliance (CHC) or equivalent compliance credential preferred.

Work Experience (Years and Area): 4-6 years of experience in healthcare compliance, including Medicare Advantage, D-SNP or duals programs. Knowledge of CMS Medicare regulations, HPMS, Medicaid Regulations. Demonstrated experience with compliance monitoring, regulatory implementation, policy review, investigation reporting and monitoring required.

4-7 years of progressive compliance experience with a Medicare health plan preferred.

Management Experience (Years and Area): 0-2 years of compliance management required.

2 or more years of compliance management preferred.

Software Proficiencies: Microsoft Office Suite (Word, Excel, PowerPoint, Teams)

Regulatory / compliance tracking systems. Data reporting and dashboard tools

Experience implementing a regulatory compliance tracking system (GRC tool) preferred.

Job Family/Job Title Competencies

Analytical Thinking

Attention to Detail

Planning and Organizing

Critical Thinking